title: Outcomes following Malone antegrade continence enema and their surgical revisions.
abstract: OBJECTIVE
  The Malone antegrade continence enema (MACE) channel is an effective means to manage patients with neurogenic bowel; however, complications may occur that may require surgical revision. Specific reports of the outcomes of these interventions are limited. We describe our clinical results following revision of MACE.
  
  
  METHODS
  We retrospectively identified patients undergoing MACE revision for at our institution between 1997 and 2009. Type of MACE (in situ appendicocecostomy (AC = 247), ileocecostomy (IC = 25), cecal flap (CF = 10)) performed was recorded, time from creation to revision, site of revision, and need for repeat surgical revision were recorded.
  
  
  RESULTS
  Of a total of 282 patients that underwent creation of MACE during the study period, 49 patients (17%) required surgical revision. Of these 49 patients, 42 had undergone AC, four had IC and three had CF. Mean time from MACE creation to revision was 19 months. Sixty-eight revision procedures were performed in the 49 patients. Skin level or endoscopic procedures accounted for 52/67 (78%) procedures. Sixteen patients (33%) required more than one revision and three patients (6%) required more than two procedures.
  
  
  CONCLUSIONS
  Skin level revisions accounted for over three-fourths of MACE revisions. In our series, two thirds of patients requiring revision required only a single procedure, but one third required more than one revision.
authors.affiliation: Department of Urology at James Whitcomb Riley Hospital for Children, Indianapolis, IN, USA. Electronic address: brian.vanderbrink@cchmc.org.
authors.forename: Brian A
authors.initials: BA
authors.lastname: VanderBrink
authors.forename: Mark P
authors.initials: MP
authors.lastname: Cain
authors.forename: Martin
authors.initials: M
authors.lastname: Kaefer
authors.forename: Kirstan K
authors.initials: KK
authors.lastname: Meldrum
authors.forename: Rosalia
authors.initials: R
authors.lastname: Misseri
authors.forename: Richard C
authors.initials: RC
authors.lastname: Rink
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004733:Enema / Q000379:methods*; D004766:Enterostomy / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Malone antegrade continence enema; Revision; Stomal stenosis